Abstract
Despite billions of dollars invested into Sexual and Reproductive Health and Rights (SRHR) efforts, the effect of incorporating sexual pleasure, a key driver of why people have sex, in sexual health interventions is currently unclear. We carried out a systematic review and meta-analysis following PRISMA guidelines across 7 databases for relevant articles published between 1 January 2005-1 June, 2020. We included 33 unique interventions in our systematic review. Eight interventions reporting condom use outcomes were meta-analyzed together with a method random effects model. Quality appraisal was carried out through the Cochrane Collaborations' RoB2 tool. This study was pre-registered on Prospero (ID: CRD42020201822). We identified 33 unique interventions (18886 participants at baseline) that incorporate pleasure. All included interventions targeted HIV/STI risk reduction, none occurred in the context of pregnancy prevention or family planning. We find that the majority of interventions targeted populations that authors classified as high-risk. We were able to meta-analyze 8 studies (6634 participants at baseline) reporting condom use as an outcome and found an overall moderate, positive, and significant effect of Cohen's d = 0·37 (95% CI 0·20-0·54, p < 0·001; I2 = 48%; τ2 = 0·043, p = 0·06). Incorporating sexual pleasure within SRHR interventions can improve sexual health outcomes. Our meta-analysis provides evidence about the positive impact of pleasure-incorporating interventions on condom use which has direct implications for reductions in HIV and STIs. Qualitatively, we find evidence that pleasure can have positive effects across different informational and knowledge-based attitudes as well. Future work is needed to further elucidate the impacts of pleasure within SRHR and across different outcomes and populations. Taking all the available evidence into account, we recommend that agencies responsible for sexual and reproductive health consider incorporating sexual pleasure considerations within their programming.
Highlights
Decades of global commitments, investments, research, advocacy, and innovation–such as the International Conference on Population and Development in Cairo1 the Fourth World Conference on Women in Beijing [2], the Millennium Development Goals, and most recently, the Sustainable Development Goals [3] and the Generation Equality Forum [4]–have defined modern-day sexual and reproductive health and rights (SRHR), including HIV, programming and services
Our meta-analysis focuses on condom use as an outcome exclusively and aggregates eight interventions whose control group is either standard care or a matched control group isolating the role of pleasure
We find that published, randomized trials of pleasure-incorporating interventions are most prevalent in populations considered at high-risk in some geographical contexts and we point to large gaps in our evidence base, including populations otherwise well-studied in the SRHR literature, such as women of a reproductive age, heterosexual individuals, and members of the general population who are not considered to be at high-risk for HIV/STIs
Summary
Investments, research, advocacy, and innovation–such as the International Conference on Population and Development in Cairo the Fourth World Conference on Women in Beijing [2], the Millennium Development Goals, and most recently, the Sustainable Development Goals [3] and the Generation Equality Forum [4]–have defined modern-day sexual and reproductive health and rights (SRHR), including HIV, programming and services. Sexual pleasure, a key reason why people have sex, remains insufficiently addressed in most areas in the world [5,6,7,8] This gap has been acknowledged by Sexual health interventions with pleasure incorporation: A systematic review and meta-analysis the Guttmacher-Lancet Commission on SRHR in 2018 [9] where aspects of sexual health, including sexual pleasure, were considered as “largely absent from organised SRHR programmes and their links to reproductive health . To our knowledge, this is the first systematic review of interventions incorporating pleasure beyond condom eroticization. Our systematic review and meta-analysis provide evidence for the effectiveness of different interventions incorporating pleasure for a variety of outcomes related to behavior, attitudes, and knowledge in the context of sexual health. We further provide a quality assessment of the existing evidence base and report on how interventions vary in the degree to which they incorporate pleasure
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